Form 2300F© 2004 Nationwide Publishing Company, Inc.http://www.claimspages.comPROPERTY LOSS WORKSHEETClaim Number: Insured:Claimant: Adjuster:Preliminary Estimate: $ Final Estimate: $1 2 3 4 5 6 7 8 9ITEM DESCRIPTION QUANTITY UNITS PRICE COSTAGE ORG. COST REP.COST DEPREC. A.C.V. LOSS -DAMAGEINSTRUCTIONS-Columns 4-9, unshaded column headings are for building or boat loss estimates. Unshaded columns 7, 8, and 9 areavailable for additional extensions such as deductions %, deductions $, total cost, etc. As required. Shaded headings are for use oncontents... Download File
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Generic form used by independent adjusters to acknowledge receipt of a property insurance claim, and provide a preliminary report to the insurance company.
Form 2030F © 2003 Nationwide Publishing Company, Inc. http://www.claimspages.com SUBROGATION RECEIPT RECEIVED FROM (Hereinafter referred to as “Company”) THE SUM OF DOLLARS ($) as a loan, without interest, repayable only in the event and to the extent of any net recovery the undersigned may make from any person, persons, corporations,...
Form 2040F © 2004 Nationwide Publishing Company, Inc. http://www.claimspages.com STATEMENT AS TO FULL COST OF REPAIR OR REPLACEMENT UNDER THE REPLACEMENT COST COVERAGE SUBJECT TO THE TERMS AND CONDITIONS OF THIS POLICY To the Ins. Co. of Policy No.. Agency at Agent. Insured. Location. Type of property involved in claim. Date of...
Form 2020F © 2003 Nationwide Publishing Company, Inc. http://www.claimspages.com RELEASE & SUBROGATION RECEIPT RECEIVED FROM (Hereinafter referred to as “Company”) THE SUM OF DOLLARS ($) in full payment, release and discharge of all claims and demands of the undersigned against the said Company, arising from or connected with any...
Form used by service providers to obtain direct payment for a loss. The owner of the damaged property signs the form which certfies his/her satisfaction and instructs the insurance company to make direct payment to the service provider.
Form 1210F © 2004 Nationwide Publishing Company, Inc. http://www.claimspages.com . PROOF OF LOSS (AIRCRAFT) Make and Type Gov. I.D. No. When Seating ENGINES Airplane, Seaplane, Flying Boat Mfrs. Serial No. Constructed Cap. H.P. Type I.D. Year Coverage: Against the perils of Description: Aloss occurred on the day of , 20 about the...
Form 1170F © 2004 Nationwide Publishing Company, Inc. http://www.claimspages.com . SWORN STATEMENT IN PROOF OF LOSS (MOBILE HOME) Name of Insured: Policy No. Date of Loss: Amount Claimed $ Time of Loss: M. DESCRIPTION OF INSURED MOBILE HOME OR RECREATIONAL VEHICLE INSURED PERSONAL EFFECTS…………………………………………$ Damage to the above...
Guidelines and Requested Data for Electrical Systems at Fire Scenes Please spend a few minutes to document how you found the system and what you did. This information may be critical in forensically reconstructing what happened to cause the fire. Guidelines 1. Safety First! These guidelines are in addition to all applicable codes, standards,...
Guidelines and Requested Data for Electrical Systems at Fire Scenes for Fire Departments Please spend a few minutes to document how you found the system and what was done. This information may be critical in forensically reconstructing what happened to cause the fire. Guidelines 1. Safety First! These guidelines are in addition to all...
Form 2140F © 2004 Nationwide Publishing Company, Inc. http://www.claimspages.com STATEMENT OF LOSS Schedule “A” Policy Form: Agency: Date of Loss: File Number: Item $ on Item $ on Item $ on Item $ on Item $ on Item $ on Item $ on Location: COINSURANCE, DISTRIBUTION, DEDUCTIBLE CLAUSE Schedule “B” Est. Replacement Cost: $ Value:...
SERVICE PANEL DATASHEET, Address: Owner: Sub or Main Panel (circle one), Voltages Used: , # phases: , Main C.B./fuse rating: A Mfg: , Main Breaker: A, On/Off/Tripped Other info: <------------LEFT SIDE OF PANEL------------------ ----------------RIGHT SIDE OF PANEL-------------- Written info/notes/ wire size/color Status On/off/tr Amp Rating Pos...
Form 2660F © 2004 Nationwide Publishing Company, Inc. http://www.claimspages.com INSURED’S STATEMENT AND CLAIM FORM (THEFT-BURGLARY LOSS) Name: Telephone Number: Address: City: State: Zip Code: Occupation: Spouse’s Occupation: Employer: Spouse’s Employer: Date of Loss: Time: Loss Location: Theft From: PRIVATE DWELLING AUTO APARTMENT...
Home Inventory Checklist Maintaining a room-by-room inventory of your personal property can be extremely helpful if you ever have an insurance claim. A detailed inventory can help speed up the claims process and can also help prove taxdeductible, uninsured losses. This checklist can help you get started. Tips for making a home inventory: Your...
An ACORD form for calculating the replacement cost of a residential dwelling using the Boeckh square foot method. This form is used by insurance agents to determine how much coverage should be written when an application is submitted, and by insurance claims adjusters after a loss when checking the adequacy of coverage per the coinsurance clause.
Digital Photo Sheet 2
A loss report form filled out by an insured when reporting a theft claim to and insurance company. Includes circumstances of the theft, and a list of items claimed as stolen with declared values.
The Adjusters Report/Certification form is similar to form 2110F but includes more detail regarding structural, contents and additional living expense payment recommendations. The adjuster certifies the loss and requests payment with this form.
Create your own time line using this Microsoft Excel template. Just enter dates and labels.
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